Effectiveness (Answer: B)
This electronic system intervention primarily addresses Effectiveness, as it ensures evidence-based HbA1c testing is systematically provided to all diabetic patients who could benefit, thereby preventing underuse of scientifically validated monitoring. 1, 2
Rationale Based on IOM Quality Framework
The Institute of Medicine defines Effectiveness as providing services based on scientific knowledge to all who could benefit, avoiding underuse of beneficial interventions. 2 This is precisely what the electronic system accomplishes by ensuring timely HbA1c testing occurs according to evidence-based guidelines.
Why This is Effectiveness:
The American Diabetes Association recommends HbA1c testing at least twice per year in patients meeting treatment goals, and quarterly in those whose therapy has changed or who are not meeting glycemic goals. 1, 2 The electronic system ensures these evidence-based testing intervals are met systematically. 2
HbA1c reflects average glycemia over approximately 3 months and has strong predictive value for diabetes complications. 1, 2 Timely testing enables appropriate treatment adjustments to prevent long-term complications. 1, 2
Electronic medical record implementation can significantly increase the frequency of HbA1c testing, demonstrating that these systems effectively prevent underuse of evidence-based monitoring. 2 Research confirms EMR use led to increased HbA1c testing frequency. 3
National quality programs include HbA1c control measures as core diabetes quality metrics. 1, 2
Why Not the Other Dimensions:
Efficiency involves reducing waste, cost, or duplicative services while maintaining quality, which is not the primary focus of ensuring timely testing. 2
Patient-centeredness prioritizes individual patient preferences, values, and needs in care delivery—the electronic system focuses on systematic adherence to clinical guidelines rather than individualized preferences. 2
Equity addresses disparities across different populations, which is not the primary purpose of this universal testing reminder system. 2
Clinical Context:
Computerized provider order entry systems with structured order sets provide computerized guidance for glycemic management and have been shown to improve the percentage of time individuals spend in the glycemic goal range. 2
Quality improvement programs using electronic health records have demonstrated 15.5% relative improvement in patients with HbA1c >9% and statistically significant reductions in HbA1c undertesting. 4